Fixation of supraglenoid tubercle fractures using distal femoral locking plates in three Warmblood horses

SummaryThree horses that were presented with supraglenoid tubercle fractures were treated with open reduction and internal fixation using distal femoral locking plates (DFLP). Placing the DFLP caudal to the scapular spine in order to preserve the suprascapular nerve led to a stable fixation, however, it resulted in infraspinatus muscle atrophy and mild scapulohumeral joint instability (case 1). Placing the DFLP cranial to the scapular spine and under the suprascapular nerve resulted in a stable fixation, however, it resulted in severe atrophy of the supraspinatus and infraspinatus muscles and scapulohumeral joint instability (case 2). Placing the DFLP cranial to the scapular spine and slightly overbending it at the suprascapular nerve passage site resulted in the best outcome (case 3). Only a mild degree of supraspinatus and infraspinatus muscle atrophy was apparent, which resolved quickly and with no effect on scapulohumeral joint stability. In all cases, fixation of supraglenoid tubercle fractures using DFLP in slightly different techniques led to stable fixations with good long-term outcome. One case suffered from a mild incisional infection and plates were removed in two horses. Placement of the DFLP cranial to the scapular spine and slightly overbending it at the suprascapular nerve passage prevented major nerve damage. Further cases investigating the degree of muscle atrophy following the use of the DFLP placed in the above-described technique are justified to improve patient outcome.

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Evaluation of the optimal plate position for the fixation of supraglenoid tubercle fractures in warmbloods

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-16-08-0121 ◽

2017 ◽

Vol 30 (02) ◽

pp. 99-106 ◽

Cited By ~ 3

Author(s):

Sina Frei ◽

Hans Geyer ◽

Seamus Hoey ◽

Anton Fuerst ◽

Andrea Bischofberger

Keyword(s):

Computed Tomography ◽

Bone Density ◽

Connective Tissue ◽

Suprascapular Nerve ◽

Hounsfield Units ◽

Stable Fixation ◽

Density Measurements ◽

Surgical Access ◽

Infraspinatus Muscle ◽

Scapular Spine

SummaryObjectives: To determine scapular cortex thickness, distal scapular bone density and describe the exact suprascapular nerve course to evaluate the best plate position for the fixation of supraglenoid tubercle fractures in horses.Methods: Twelve equine cadaveric shoulders were examined with computed tomography. Computed tomography morphometry and density measurements (Hounsfield units [HU]) of the scapula were recorded. Statistical comparisons were made between the cranial and caudal aspects of the scapula. Dissection of each shoulder was performed and the suprascapular nerve course was described morphometrically and morphologically.Results: The suprascapular nerve was found on the periosteum and embedded in connective tissue at the cranial aspect of the scapula. It ramified proximally and distally into the supraspinatus muscle, coursed caudo laterally at a median of 2 cm (1–2 cm) distal to the scapular spine and ramified proximally and distally into the infraspinatus muscle. The scapular cortex measurements (HU) cranially were significantly larger than caudally at most levels of the scapula. The bone density of the distal scapula cranially (651.3 ± 104.2) was significantly lower than caudally (745.7 ± 179.1).Clinical significance: For surgical access to the supraglenoid tubercle, knowledge of the anatomy is important. It is easiest to avoid the suprascapular nerve at the most cranial aspect of the scapula, where it has not yet ramified. For a stable fixation, knowledge of the characteristics of the equine scapula, such as scapular cortex thickness, is important.

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POS1276 LONG TERM OUTCOME OF MULTIPLE ULTRASOUND GUIDED SUPRASCAPULAR NERVE BLOCK IN TREATMENT OF FROZEN SHOULDER IN DIABETIC PATIENTS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2951 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 922.2-922

Author(s):

M. A. Mortada ◽

R. Hassan ◽

Y. A. Amer

Keyword(s):

Nerve Block ◽

External Rotation ◽

Frozen Shoulder ◽

Suprascapular Nerve ◽

Diabetic Patients ◽

Ultrasound Guided ◽

Term Outcome ◽

Long Term Outcome ◽

Suprascapular Nerve Block

Background:Frozen shoulder is prevalent among diabetic patients, and usually has aggressive course, with more tendency to be bilateral and resistant to treatment. Suprascapular nerve block (SSNB) is used with increasing frequency by anesthetists and rheumatologists in the management of frozen shoulder. We previously introduced a protocol of nine injections for SSNB with better short term outcome than single SSNB injection (1). Long term outcome of SSNB in management of frozen shoulder is still not detected.Objectives:To evaluate the long term effect of multiple (nine) ultrasound guided supra-scapular nerve block in treatment of diabetic frozen shoulder.Methods:A retrospective cohort study followed up 40 diabetic patients who received a course of ultrasound guided multiple supra-scapular nerve block (9 injections) on 2014. In this study we retrospectively assessed the patients from previously recorded data at a mean duration of 6 years after completing the 9 injection course SSNB clinically by measuring the shoulder active range of motion (using a goniometer in three planes: abduction, internal, and external rotation). Visual analogue scale and Functional assessment by shoulder pain and disability index (SPADI).Results:Thirty four patients (85% of original cohort) completed the long term follow up.The patients were 19 (55.9%) females, 60.6 y mean age, and the mean of disease duration was 85.6 months. The majority of patients (33 patients 97.05%) continues improvement and gained within normal complete range of motions in all directions and excellent grades of shoulder function (Table 1).Table 1.Clinical ParametersAt base lineAt 4 monthsLast follow up at (72months±4)**P valueSPADI pain score (100)(68.8 ± 0.5)a(10.3 ± 7.4)b(0.9±1.9)c0.00*SPADI disability score (100)(69.2 ± 7.7)a(6.25 ± 2.25)b(0.4±0.8)c0.00*SPADI total (100)(69.1 ± 8.5)a(8.15 ± 5.4)b(1.1±0.9)c0.00*Patient global assessment (100)(90.2 ± 8.2)a(8.2 ± 4.2)b(0.4±2.1)c0.00*Night pain (100)(55.4±10.2)a(10.3 ± 4.9)b(2.3±1.1)c0.00*Abduction (180°)(77.5 ± 4.7)a(170.3 ± 10.3)b(174.2±6.2)b0.00*External rotation (100 °)(46 ± 12.6)a(80.1 ± 10.2)b(86.4±10.3)b0.00*Internal rotation (70 °)(34.5 ± 2.4)a(55.4 ± 10.1)b(60.2±9.5)b0.00** P <0.05 there was a statistical significant difference•A,b,c--- the alphabet of different symbols ---means a significant statistical difference between groupsSPADI: shoulder pain and disability indexConclusion:The multiple injection courses for supra-scapular nerve block has an excellent long term efficacy as treatment of diabetic frozen shoulder. This method should be the treatment of choice in patients of diabetic frozen shoulder who do not respond to physiotherapy.References:[1]Mortada, M. A., Ezzeldin, N., Abbas, S. F., Ammar, H. A. & Salama, N. A. Multiple versus single ultrasound guided suprascapular nerve block in treatment of frozen shoulder in diabetic patients. J. Back Musculoskelet. Rehabil. 30, 537–542 (2017).Disclosure of Interests:None declared

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Infraspinatus muscle atrophy from suprascapular nerve compression

Journal of the American Academy of Physician Assistants ◽

10.1097/01.jaa.0000442701.87975.42 ◽

2014 ◽

Vol 27 (2) ◽

pp. 33-35 ◽

Cited By ~ 4

Author(s):

Christopher B. Cordova ◽

Brett D. Owens

Keyword(s):

Muscle Atrophy ◽

Suprascapular Nerve ◽

Nerve Compression ◽

Infraspinatus Muscle

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Isolated and painless (?) atrophy of the infraspinatus muscle: left handed versus right handed volleyball players

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x1994000400014 ◽

1994 ◽

Vol 52 (4) ◽

pp. 539-544 ◽

Cited By ~ 9

Author(s):

Thiago D. Gonçalves Côelho

Keyword(s):

Brachial Plexus ◽

Muscle Atrophy ◽

Suprascapular Nerve ◽

Nerve Entrapment ◽

Suprascapular Notch ◽

Supraspinatus Muscle ◽

Left Handed ◽

Infraspinatus Muscle ◽

Volleyball Players ◽

Spinoglenoid Notch

The suprascapular nerve originates from the upper trunk of the brachial plexus or less frequently from the root of C5. It runs a short way and crosses the suprascapular notch. It innervates the supraspinatus muscle and the acromioclavicular and glenohumeral joints. Then, it crosses the lateral edge of the spine of the scapula passing through the spinoglenoid notch, and innervates the infraspinatus muscle. These are potential sites of injury to the suprascapular nerve. Three cases of suprascapular nerve entrapment causing an isolated infraspinatus muscle atrophy in volleyball players were studied. It is suggested the hypothesis that the nature of the smash, in which the athlete uses the arm violently, more than does in volleyball service or in the art of reception, is the key to the pathogenesis of the lesion in volleyball players.

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